Esophageal Fully-Covered Metal Stent as a Rescue Therapy for a Strasberg Type A Biliary Leak in a Huge Common Bile Duct Dilation.

Treatment of biliary leaks is challenging and complex. Even if endoscopic sphincterotomy with biliary stenting is usually resolutive in restoring the original bile flow, common bile duct (CBD) diameter is crucial in defining the size and features of the stent. Additional factors, such as uncommon anatomical reconstructions due to a previous abdominal surgery, could make the endoscopic approach more difficult, therefore increasing the risk of failure. Many articles deal with uncommon technique adopted to allow an optimal healing of biliary leaks but, thus far, only two reports of biliary stent using an esophageal through-the-scope (TTS), partially-covered, self-expandable metal stent (SEMS) exist in the current literature. This article describes the deployment of an esophageal SEMS into the CBD for a refractory type A Strasberg fistula in a Billroth-II reconstruction. To our knowledge, this is the first report concerning the use of an esophageal stent for CBD drainage in a Billroth-II reconstruction.

Rendezvous endoscopy using a transillumination fashion as a feasible and safe alternative to endoscopic ultrasound-guided recanalization in case of complete anastomotic stricture.

Complete colorectal anastomotic strictures are rare and difficult to solve surgical complications. In case of failure of endoscopic ultrasound-guided recanalization (usually the first choice treatment), rendezvous maneuver using a transillumination fashion represents a feasible and safe procedure to reconstitute the completely obstructed colonic lumen.

Rescheduling/scheduling of endoscopic procedures during "Phase-Two: which precautions should be taken?" Experience and results of a single Italian Endoscopic Unit.

Not required.

Diagnosis and management of intraductal papillary mucinous neoplasms of the pancreas. An Useful Update with a Noteworthy Tip.

Not requested.

Endoscopic Full-thickness Resection with the Full-Thickness Resection Device (FTRD) for "difficult to resect" colonic lesions. A single-center experience.

INTRODUCTION: Aim of our observational and retrospective study is to compare efficacy and indications of endoscopic full-thickness resection device (FTRD) with the over-the-scope (OVESCO) clip closure for en bloc resection of colorectal lesions (including adenomas, early carcinomas, inflammatory polyps and neuroendocrine tumors). MATERIAL AND METHODS: This article collected 36 cases of colorectal neoplasms from a single Italian referral center per colorectal disease treatment. Primary endpoints included en bloc resection, R0 resection and an early discharge of the patient. Secondary endpoints included procedure-related adverse events. RESULTS: Mean procedure time± standard deviation (SD) was 19.6±22.1 minutes and mean hospital stay (± SD) was 2.2±1.1 days. Overall, an en bloc resection was achieved in 34 cases (94.4%), with an R0 resection rate of 91.6%. Among the three not R0 patients, further additional treatments were needed. DISCUSSION: Along the same line of other already published articles, the main current indications of EFTR by FTRD-OVESCO are limited to superficial or low-risk malignancy lesions (eg, adenomas, early cancers or subepithelial tumors), not suitable to conventional endoscopic resection or in patients with a severe surgical risk. Both en bloc resection rate and complication rate are aligned with other authors' data. CONCLUSIONS: EFTR by FTRD system represents an effective and safe options whenever a recurrent lesion in a challenging environment occurres (eg, recent scar, low rectum or beyond a large colonic bend). Procedure-related adverse events are potentially severe, so that this novel technique should be performed by "expert hands". KEY WORDS: Difficult polypectomies, Early carcinomas, Endoscopic Full-Thickness Resection (EFTR), Full-Thickness Resection Device (FTRD) by Over-The-Scope (OVESCO) clip closure, Literature overview, Single center experience.

Comparison among different techniques for en-bloc resection of rectal lesions: transanal endoscopic surgery vs. endoscopic submucosal dissection vs. full-thickness resection device with Over-The-Scope Clip® System.

BACKGROUND: The aim of our retrospective study is to compare the efficacy and indications of transanal endoscopic microsurgery (TEM), endoscopic submucosal dissection (ESD), and endoscopic full-thickness resection device (FTRD) with Over-The-Scope Clip (OTSC®) System for en-bloc resection of rectal lesions. METHODS: This study collected 76 cases of rectal neoplasms from a single hospital institution. Primary endpoints were complete en-bloc resection, intraprocedural adverse events, R0 en-bloc resection and an early discharge of the patient. Secondary endpoints included procedure-related adverse events. RESULTS: Mean tumor sizes were statistically significant smaller among patients treated with FTRD rather than TEM and ESD. TEO and FTRD treated patients experienced a higher en-bloc resection rate, with a shorter procedure time and hospital stay. No significant difference concerning the R0 resection was found. TEO and FTRD recorded lower perforation rates as compared to ESD, whereas no difference emerged concerning the bleeding rate and the post-polypectomy syndrome rate. CONCLUSIONS: Our study showed that each technique has specific features, so that each one offers advantages and disadvantages. Nevertheless, all of them ensure high en-bloc resection rates, whereas no difference exists for R0 resection rate. TEO provides the possibility to remove low rectal large lesions as compared to ESD and FTRD.

"Risk of tumor implantation in percutaneous endoscopic gastrostomy in the upper aerodigestive tumors". Can the "non-pull" methods and the surgical approaches be definitively discarded?

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Routine use of simultaneous laparoendoscopic approach in patients with confirmed gallbladder and bile duct stones: fit for laparoscopy fit for "rendezvous".

BACKGROUND: The aim of the present work was to determine the feasibility and efficacy, in terms of equipment coordination and timing, of the laparoendoscopic intraoperative rendezvous technique (RVT) for the treatment of gallbladder and common bile duct stones (CBDS). METHODS: The procedure was considered in 269 unselected patients with a suspicion or preoperative imaging demonstration of CBDS who were fit for laparoscopic cholecystectomy (LC). Common bile duct stones were confirmed by intraoperative laparoscopic cholangiography (IOC) in only 113 of these patients (42 %). In 17 (15 %) patients the planned procedure was aborted because of organizational problems, mainly the unavailability of endoscopists in the urgent setting. The remaining 96 patients (84 %) underwent a formal attempt at RVT. Intraoperative endoscopic retrograde cholangiography (ERC) was performed, during LC, by means of a guidewire that reached the duodenum through the cystic duct. RESULTS: In 18 patients (19 %) the complete procedure failed, either because of difficulty in passing the guidewire through the papilla or because of other technical difficulties that required conversion to laparotomy. An intraoperative ERC was completed in six patients in the classical way (no guidewire) without conversion. No mortality and few complications were recorded (3 % overall: 1 perforation and 2 cholangitis). Retained stones were successively detected in 6 patients (6 %) and successfully retreated by a further ERC. Globally, the one-stage procedure (with and without the guidewire) was possible in 84 of 96 patients (87 %). CONCLUSIONS: The RVT appears to be effective and safe as it was performed at our institution, with an overall percentage of definitive success (passed guide wire and no further ERC) of 81 %. The RVT should be considered as a good option for the treatment of simultaneous gallstones and CBDS.